Knowledge Bomb

Knowledge Bomb: Route of Diltiazem in Afib with RVR

We continue the series with Knowledge Bomb #21. The purpose and motivation for this series is outlined in the first entry and extensively in an ALiEM IDEA series blog entry. Background Atrial fibrillation (afib) with rapid ventricular rate (RVR) can lead to adverse effects on cardiovascular hemodynamics. Sustained elevated rates of disorganized atrial electrical activity leads to the absence

Knowledge Bomb

Knowledge Bomb: Fluid Resuscitation in Pediatric DKA

We continue the series with Knowledge Bomb #20. The purpose and motivation for this series is outlined in the first entry and extensively in an ALiEM IDEA series blog entry. Background Cerebral edema is one of the most feared complications in pediatric patients with diabetic ketoacidosis (DKA). It is the leading cause of death from this disease process. Thankfully

EM/IM Sessions

EM/IM Sessions: Hypothermia for In-Hospital Cardiac Arrest

Association Between Therapeutic Hypothermia and Survival After In-Hospital Cardiac Arrest. Chan, Paul  et al. JAMA. Oct 2016. [paper] Why I chose this study I recently rotated through the ICU and experienced multiple in-hospital cardiac arrests. There is research that suggests therapeutic hypothermia improves outcomes for out-of-hospital cardiac arrest. We were cooling patients with in-hospital cardiac arrest


Keeping the Beat

Heart Failure for the Resuscitationist: The Basics I don’t have to tell you that heart failure is a common condition in the general population and in patients presenting to the emergency department (ED). We see it on a daily basis. Even with this familiarity there are still some conundrums in the care of these patients.

EM/IM Sessions

EM/IM Sessions: Preoxygenation with Flush Rate O2

Preoxygenation With Flush Rate Oxygen: Comparing the Nonrebreather Mask With the Bag-Valve Mask Driver, Brian E et al. Annals of Emergency Medicine, March 2018. [paper] Why I chose this study While preoxygenating during rapid sequence intubation for spontaneously breathing patients, I’ve typically used bag valve mask (BVM) and nonrebreather mask (NRB) interchangeably. This is mainly based

EM/IM Sessions

EM/IM Sessions: Impella for Refractory Cardiac Arrest

The Impella CP Device for Acute Mechanical Circulatory Support in Refractory Cardiac Arrest Vase H, Christensen S, Christiansen A, et al. Resuscitation 2017. [paper] Why I chose this study While perusing LITFL R&R I stumbled on this interesting study. As we have started seeing with increased use of ECMO and the development of tools such as

Critical Care

We Have No Beds: Ventilator Series

We Have No Beds: Ventilator Series Assist Control So now that we have discussed how to read a ventilator screen, let’s discuss our first mode of ventilation… Assist Control (AC) This mode has the ability to completely control the patients ventilatory status. With this mode you set the rate, the means by which tidal volume is

Critical Care

The Sedation Vacation

Sedation Vacations in the Intensive Care Unit Sorry, pure EM folk, this topic primarily applies to the unit. For most of us, the idea of a “daily sedation vacation” is probably a familiar and standard practice in the intensive care unit (ICU). Generally defined, a sedation vacation is when sedatives are discontinued for a period

High Yield for the Field

HYFTF: Hypertensive Emergencies

Written and Edited by Dr. Jessica Zahn

EM/IM Sessions

EM/IM Sessions: VANISH Trial

Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Gordon, AC, et al. JAMA 2016 [paper] Why I chose this article The kidney is painfully fragile, often one of the first organs to fail in septic shock. According to the last several iterations of the Surviving Sepsis Campaign Guidelines,